Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK.
Department of General Practice, Primary Care Cancer Research, University of Melbourne, Carlton, Victoria, Australia.
BMJ Open. 2017 Sep 3;7(9):e015682. doi: 10.1136/bmjopen-2016-015682.
Pancreatic cancer has poor survival rates due to non-specific symptoms leading to later diagnosis. Understanding how patients interpret their symptoms could inform approaches to earlier diagnosis. This study sought to explore symptom appraisal and help-seeking among patients referred to secondary care for symptoms suggestive of pancreatic cancer.
Qualitative analysis of semistructured in-depth interviews. Data were analysed iteratively and thematically, informed by the Model of Pathways to Treatment.
Pancreatic cancer occurs rarely in younger adults, therefore patients aged ≥40 years were recruited from nine hospitals after being referred to hospital with symptoms suggestive of pancreatic cancer; all were participants in a cohort study. Interviews were conducted soon after referral, and where possible, before diagnosis.
Twenty-six interviews were conducted (cancer n=13 (pancreas n=9, other intra-abdominal n=4), non-cancer conditions n=13; age range 48-84 years; 14 women). Time from first symptoms to first presentation to healthcare ranged from 1 day to 270 days, median 21 days. We identified three main themes. Initial symptom appraisal usually began with intermittent, non-specific symptoms such as tiredness or appetite changes, attributed to diet and lifestyle, existing gastrointestinal conditions or side effects of medication. Responses to initial symptom appraisal included changes in meal type or frequency, or self-medication. Symptom changes such as alterations in appetite and enjoyment of food or weight loss usually prompted further appraisal. Triggers to seek help included a change or worsening of symptoms, particularly pain, which was often a 'tipping point'. Help-seeking was often encouraged by others. We found no differences in symptom appraisal and help-seeking between people diagnosed with cancer and those with other conditions.
Greater public and healthcare professional awareness of the combinations of subtle and intermittent symptoms, and their evolving nature, is needed to prompt timelier help-seeking and investigation among people with symptoms of pancreatic cancer.
由于非特异性症状导致诊断较晚，胰腺癌患者的生存率较差。了解患者如何解释其症状可以为早期诊断提供信息。本研究旨在探讨因疑似胰腺癌而转至二级保健的患者的症状评估和寻求帮助的情况。
半结构式深入访谈的定性分析。数据通过治疗途径模型进行迭代和主题分析。
年轻患者中胰腺癌的发病率较低，因此，从九家医院招募了年龄≥40 岁的患者，这些患者因疑似胰腺癌的症状而被转至医院；他们都是队列研究的参与者。访谈是在转诊后不久进行的，如有可能，在诊断之前进行。
共进行了 26 次访谈（癌症组 13 例（胰腺 9 例，其他腹腔内 4 例），非癌症组 13 例；年龄范围 48-84 岁；女性 14 例）。从首次出现症状到首次向医疗保健机构就诊的时间从 1 天到 270 天不等，中位数为 21 天。我们确定了三个主要主题。最初的症状评估通常始于间歇性、非特异性症状，如疲劳或食欲改变，归因于饮食和生活方式、现有的胃肠道疾病或药物副作用。对初始症状评估的反应包括改变用餐类型或频率，或自我用药。食欲和享受食物或体重减轻等症状变化通常会进一步评估。寻求帮助的触发因素包括症状的变化或恶化，特别是疼痛，这通常是一个“转折点”。寻求帮助通常是受到他人的鼓励。我们没有发现癌症诊断组和其他疾病诊断组在症状评估和寻求帮助方面存在差异。
需要提高公众和医疗保健专业人员对微妙和间歇性症状的组合及其演变性质的认识，以促使有胰腺癌症状的人更及时地寻求帮助和进行调查。
